title: Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review.
abstract: BACKGROUND
  Research has found some disparities between U.S. women with and without disabilities in receiving clinical preventive services. Substantial differences may also exist within the population of women with disabilities. The current study examined published research on Pap smears, mammography, and clinical breast examinations across disability severity levels among women with disabilities.
  
  
  METHODS
  Informed by an expert panel, we followed guidelines for systematic literature reviews and searched MEDLINE, PsycINFO, and Cinahl databases. We also reviewed in-depth four disability- or preventive service-relevant journals. Two reviewers independently extracted data from all selected articles.
  
  
  RESULTS
  Five of 74 reviewed publications of met all our inclusion criteria and all five reported data on Pap smears, mammography, and clinical breast examination. Articles classified disability severity groups by functional and/or activity levels. Associations between disability severity and Pap smear use were inconsistent across the publications. Mammography screening fell as disability level increased according to three of the five studies. Results demonstrated modestly lower screening, but also were inconsistent for clinical breast examinations across studies.
  
  
  CONCLUSIONS
  Evidence is inconsistent concerning disparities in these important cancer screening services with increasing disability levels. Published studies used differing methods and definitions, adding to concerns about the evidence for screening disparities rising along with increasing disability. More focused research is required to determine whether significant disparities exist in cancer screening among women with differing disability levels. This information is essential for national and local public health and health care organizations to target interventions to improve care for women with disabilities.
authors.affiliation: Department of Public Health & Preventive Medicine, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon 97239, USA. andresee@ohsu.edu
authors.forename: Elena M
authors.initials: EM
authors.lastname: Andresen
authors.forename: Jana J
authors.initials: JJ
authors.lastname: Peterson-Besse
authors.forename: Gloria L
authors.initials: GL
authors.lastname: Krahn
authors.forename: Emily S
authors.initials: ES
authors.lastname: Walsh
authors.forename: Willi
authors.initials: W
authors.lastname: Horner-Johnson
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Iezzoni
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D006233:Persons with Disabilities; D055088:Early Detection of Cancer; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening; D008875:Middle Aged; D065006:Papanicolaou Test; D010808:Physical Examination; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*